“The Light Who Pursues Kindness”

Each year, our graduating class is asked to nominate a member to speak on their behalf at the Convocation ceremony.  Last week, Alex Summers delivered an address he entitled “The Light Who Pursues Kindness” on behalf of the Meds 2013 class.  It was clear to me and to many other faculty attending that Alex’s words deserved a broader audience and so, with his permission, I am providing the complete and unaltered text of his address below.  Alex’s words require no editorializing on my part, but I would simply say that all who are involved in our school in any way, be it teaching, leadership, administration or support, should take justifiable pride that our graduates should feel this way about their careers, to date and beyond.  In the midst of the day-to-day challenges we all face, Alex’s words reaffirm the faith that what we do is worthwhile, and we must be doing something right.  And so, the words of Dr. Summers:

Picture - Alexander SummersMr. Chancellor, Principal, Rector, ladies and gentlemen; 
Let me get started by taking you back to the spring of 1885 with some words borrowed from a day just like today:
“Medicine is a liberal profession, requiring culture and knowledge and skill. It is not a trade for money making, nor a field for vaulting ambition. The physician’s object is to combat disease; he is, therefore, the servant of the suffering.”
Those are the words of George Spankie, Queen’s Medicine 1885, spoken during his convocation address. Since the fall of 1854, medical students have trained here at Queen’s. Trained, and despite all the doubts, graduated too. And today, it’s our turn to cross this stage. We’ve been done for almost a month, but I know many of us have been resisting the urge to call each other doctor, for as we know from last week’s hockey game, it isn’t over till it’s over. Unless you’re the Senators of course; even Alfie says it’s over. But be re-assured folks, I think we’ve made it.
My hope today is to quote the collective voice of the Class of 2013, an outstanding group of people for whom my respect and admiration has grown daily since September 2009. To my classmates, may the words I speak for you today echo your thoughts, and may the words I speak to you have value and meaning. For the wisdom imparted, the memories shared, the friendship and support, and for the humbling privilege to stand here today, thank you.
The medical school journey is not one that is walked alone. It is only through the support of so many that we have achieved what we have achieved. To the staff of the UGME, thank you for tireless efforts on our behalf. To the faculty, we are grateful to you for so many things, but most especially for the examples of professionalism and excellence that you have modeled for us. Queen’s, in my overtly biased opinion, is a remarkable place, and it is so because of its people. Leonard Brockington, Rector of Queen’s from 1947 to 1966 (and the last non-student rector), said that this university was “…an example of the personal and national good that springs from intimate association between devoted teachers and eager learners.” That sentiment still holds true. Thank you for your commitment to us, and to Queen’s.
And to our families and friends, words simply are not enough. Our gratitude for your support, encouragement, and love, cannot be adequately conveyed from a stage. To all of you, may the lives we have lived thus far, and the lives we will lead from this day on make you proud, and be our most sincere expression of thanks.
I last addressed a graduating class in June 2002. I was fourteen years old, and it was the graduation ceremony for Grade 9 students at Montgomery Junior High School in Calgary. I do not remember one word of my speech. But I remember what followed. With spiky fluorescently dyed hair and skater shoes to accent the dress pants, Cassie, David, Terry and Cam came to the stage to play, you guessed it, the convocation classic Good Riddance, aka Time of Your Life, by the punk rock band Green Day. It was a beautiful rendition of that four-chord tune, and I even think David, the guitar player, managed to slip in that little four-letter word that follows the second prematurely attenuated guitar lick.
At the time, there was no better articulation of our feelings and hopes. The words were simple and the band was cool, and it was our anthem. Today however, 11 years later, would that song still cut it? Would it still capture the significance of a day like today?                                                   
Of course not.
Certainly, part of today is very much about remembering the last four years. But that’s not it. That song doesn’t cut it because today is only so much about yesterday. Today is about tomorrow. Not only does the university acknowledge today four years of effort by bestowing upon us this degree, in accepting that degree we answer, with humility and respect, a call. We accept a profound responsibility; a social contract between us and our neighbours. As we begin to feel the weight of that responsibility, it is good to once more reflect upon what exactly we have been called to do.
In my first year of medical school, under the guidance of Dr Duffin, I had the opportunity to learn about Dr Norman Bethune. For a man long dead, he has made a transformational impact on my understanding of what it means to be a physician. A Canadian physician of overwhelming humanitarianism and global compassion, he plied his trade across the globe, believing there was “code of fundamental morality and justice between medicine and the people.” He died in 1939 in rural China, and is remembered in that country as a hero for his selflessness and sacrifice. His name amongst the Chinese is Bai Qiu En – The Light Who Pursues Kindness.

I love that. And I find purpose and inspiration in the idea that we too can be, and should be, lights who bring and share kindness in the darkest hours of human suffering. As we go from here, we tread in the footsteps of giants like Norman Bethune and others – just look around this stage. As our forbearers have, may we stumble courageously and persistently in the pursuit of compassion and excellence. Let us never forgo the good of the patient and the public for the advancement of ourselves or the profession. If the economy does finally manage to implode on itself and the funds for public salaries disappear, may it be seen that Queen’s physicians are the ones that will still show up for work; that Queen’s physicians are, in the words of that valedictorian of old, “servant[s] of the suffering.”  Whether we are destined for a career in a ward, a clinic, an OR, a lab, or a public health unit, if we embark from this place, humbly emboldened with a commitment to pursue kindness in everything we do, we will not go wrong.

Let me finish with one more quote; with words borrowed from Dr Bethune. Spoken in 1938 at the opening of a military hospital in remote China, he would die within the year at the age of 41 as a result of a blood-borne infection he would acquire while operating on a soldier.

“There’s an old saying in the English hospitals… “A doctor must have the heart of a lion and the hand of a lady.” That means he must be bold and courageous, strong quick and decisive yet gentle, kind and considerate. Constantly think of your patients and ask “Can I do more to help them?”

Congratulations, my friends. Thank you for the last four years, for today, and most especially for the good work you will do as you go from this place.

 

Anthony J. Sanfilippo, MD, FRCP(C)
Associate Dean,
Undergraduate Medical Education

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It Takes a Village

Last week’s convocation ceremonies provided opportunities to not only pay tribute to the 2013 class, but also reflect on the progress of our school and curriculum.  I was congratulated several times for the changes that have taken place, and the success of our graduating class.  In truth, those changes have been made possible only by the efforts of many faculty and support staff, who are the real heroes of any success we’ve achieved.  I thought it appropriate to devote an article to those remarkable people.  In doing so I tread cautiously, always wary of omitting someone, but not willing to pass up the opportunity to recognize the deserving.  So, here goes:

Screen Shot 2013-05-30 at 8.54.21 AMTed Ashbury.  Several years ago, he (perhaps foolishly) Ted agreed to become a curricular advisor.  From that, he has become the “heart and soul” of Professionalism within our curriculum and within our medical school.  He began by chairing a working group that examined and developed a competency framework, the work of which served as a model for all the professional competencies.  He has continued to teach and advocate for professionalism, serving on our Curriculum Committee since it’s inception.  He does not speak often, but is always thoughtful and his usually incisive commentary often brings the group back to fundamentals and keeps our collective eye on what’s important.  I’ve come to count on his advice.  Ted’s trying to retire and I guess we’re going to have to let him do that at some point, but we don’t have to be happy about it.

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Henry Averns has, for the past 5 years directed our Clinical Skills program.  A difficult portfolio at the best of times, Henry had to manage through the departure of a number of faculty leads, transition from a five to four term format, introduction of new teaching requirements, and transition to a new Clinical Education Centre.  Henry managed all this with characteristic aplomb, the final result a program that continues to be highly regarded by our students and accreditors, and improved for his contributions.  More recently, he has taken on chairmanship of our OSCE committee, a role that continues to bring both learning and administrative challenges, but he is engaging with his usual enthusiasm and characteristic pragmatism.

belliveauPaul Belliveau has been a consistent liaison and representative of Surgery within our curriculum, both at the pre-clerkship and clerkship levels.  He has also willingly taken on a number of key roles, including initially chairing our Student Assessment Committee and taking on leadership of our Student Awards Committee as it undergoes necessary reforms.

Screen Shot 2013-05-24 at 3.55.07 PMJennifer Carpenter
has, for many years, provided counseling for students experiencing a variety of personal and health problems.  In doing so, she has made herself continuously available to them and, since most of what she does is held in confidence, she largely carries out this role without attention or fanfare.  She has also led the development of our Advocacy curriculum and promoted the development of Learner Wellness initiatives.  She is unfailingly supportive of our students, and I have come to rely on and trust her advice on many student related issues.

Screen Shot 2013-05-24 at 4.20.34 PMSue Chamberlain has been instrumental in developing our curriculum and clerkship in Obstetrics and Gynecology, shaping both into a very well regarded components of our curriculum, reflected by high levels of success of our students in Medical Council of Canada examinations and disproportionate interest in Ob-Gyn careers among our students.  For these past 4 years, she took on Chairmanship of our Student Assessment Committee.  This was a mammoth task, requiring a combination of policy development, faculty support and oversight of the curricular courses.  Her success in developing effective assessment methodologies for our courses was absolutely essential and key to our accreditation success.

 

Screen Shot 2013-05-24 at 3.57.52 PMLindsay Davidson is a dedicated and successful career educator who has also been part of our curricular transition from the start.  During her time as Clerkship Director she guided the clerkship through its transition to a 2 year model.  She has also taken on the roles of MSK Course Director for many years and, more recently, Year 2 Director.  Her overriding contributions, however, relate to her willingness to fearlessly engage novel educational models, combined with technological expertise rare in medical faculty.  She has been an unapologetic champion of small group learning techniques, leading the way and assisting many faculty in making that transition.  She has become a growing presence within the university and national education communities.

Screen Shot 2013-05-27 at 9.12.59 PMAs the Hannah Chair for the History of Medicine, Jackie Duffin has provided our students insights into the history of our profession and done so in a highly engaging manner, mixing award winning lectureship with individual research and highly regarded field trips which she personally organizes and supervises.  Her contributions, however, go far beyond that role.  She engages the students on a personal level with enthusiasm and warmth, and is held in high regard by all.  Her publications and global work bring much credit to our school.

Renee Fitzpatrick has provided steadfast and innovative leadership for all aspects of our Psychiatry curriculum.  She has developed novel approaches to teaching complex psychiatric presentations through the use of standardized patients, as well as developing individualized preparation opportunities for students undertaking the Integrated Community Clerkship.  She has become the champion of Psychiatry within the UG curriculum, and her efforts have provided our students with a much more realistic and attractive impression of that career track.  As she moves on to other challenges, she leaves strong pre-clerkship and Clerkship programs for colleagues to follow.

Michelle Gibson has skillfully and efficiently guided Year 1 of our curriculum for several years, been an important member of our Curriculum Committee (taking over responsibilities as Chair for these past 2 years), all while completing her Master’s degree in Medical Education and carrying out her practice in Geriatric Medicine.  During that time, she managed to have a baby, and young Conor has become an honorary member of Curriculum Committee, amassing an impressive attendance record.

Cherie Jones-Hiscock has provided leadership and oversight for two key competencies within our curriculum, those related to the Collaborator and Communicator roles.  In doing so, she has developed curricular content and novel, creative methods to provide that content.  These roles have required that uncommon combination of educational creativity and administrative skill.  She has brought these skills to her roles with our Professional Foundations and Curriculum Committees.

H_Macdonald_7472_Hugh MacDonald has guided our Admissions Committee through a transition to a much more sophisticated and, in my view, effective process based on an understanding of key applicant attributes and incorporating mini-medical interviews.  The committee’s mandate has also expanded to involve admission of students to our MD-PhD and QuARMS programs, each requiring creative thinking and novel processes.  Hugh has guided these processes with a steady hand and good judgment, all the time filling other key clinical and administrative roles in our school.

Screen Shot 2013-05-24 at 4.26.11 PMSue MacDonald, as our first Academic Advisor, has taken on this new role with energy and commitment.  She provides personal counseling with students experiencing academic challenges, effectively identifying opportunities for improvement and complementing the efforts of other counselors.  Many students have benefitted from her counseling and sound, practical advice.  She has also been very active in the delivery of our Professionalism/Ethics curriculum, and a strong contributor to our Student Progress and Promotions Committee.

Screen Shot 2013-05-24 at 4.17.46 PMJennifer MacKenzie has, together with Theresa Suart, developed a de novo pre-medical curriculum for our QuARMS program which is highly creative, delivering competency based learning in a variety of creative teaching formats.  This program, and Jennifer’s continued oversight, will be key to the success of this exciting new initiative.

 

Sue MoffattSue Moffatt has been making major contributions to our curriculum for more years than she would like me to mention.  Most recently, her contributions to our curricular renewal process, guidance of the Cardio-Respiratory course through transition, and wholesale development of the three Clerkship Curriculum courses have been remarkable even for someone with her track record.  Her recent selection by our graduating students to receive the Connell Award (given to the faculty member deemed to have made the greatest contributions to their medical education) speaks clearly to her dedication and commitment to our students.  It’s always clear to me and others that Sue’s perspectives and opinions on various issues, although often controversial, are always motivated by a genuine concern for the interests of our students.

Screen Shot 2013-05-24 at 4.09.58 PMHeather Murray has transformed the teaching and expression of Scholarship within our curriculum.  She has done so by developing and managing the CARL (Critical Appraisal, Research and Learning) course, now in it’s third year, and building on Albert Clarke’s longtime contributions to transform our Critical Enquiry course.  She is transforming those components of our curriulum into a very active and highly relevant learning experience for our students.  The Student Research Showcase, which she developed and offered for the first time last fall, promises to become a regular highlight of the academic year.

Screen Shot 2013-05-24 at 4.11.03 PMPeter O’Neill tirelessly guides our students through their career planning and CARMS application processes.  He also, quietly and without fanfare, provides personal guidance and advocacy for those few who have difficulty with the postgraduate match process.  In his spare time, he has developed a program in Spirituality, which has been well received by both students and other medical schools.

Conrad Reifel and Steve Pang have provided a Normal Human Structure course that is, in the view of many, among the best programs in the country.  They have also been open to change and cooperation with clinical course directors that continues to promote integration throughout our curriculum.

59Mike Sylvester has developed and operated a Family Medicine course in first semester that not only introduces our students to that specialty, but provides their first exposure to clinical presentations and diagnostic reasoning.  He has represented and promoted the integration of Generalism within our curriculum tirelessly through his participation on the Curriculum Committee.

David Taylor and Cathy Lowe have very effectively reformed our Internal Medicine Clerkship rotations, converting what were weaknesses to strengths within the clerkship.  In doing so, they have introduced innovative teaching and assessment methodologies.

Screen Shot 2013-05-24 at 4.27.25 PMLewis Tomalty, during his term as Senior Associate Dean, was a strong supporter of curricular change and continuing source of advice, guidance and support.  Since then, he has assumed responsibility for our Mechanisms of Disease course and is in the process of reforming that curriculum.

vanwylickRichard VanWylick seems to be everywhere.  He has, over the past few years, directed the development and implementation of our Pediatrics pre-clerkship curriculum, directed the Pediatric Clerkship, directed our Integrated Community Clerkship Program and, just for good measure, Chaired the Progress and Promotions Committee, a role that requires the knowledge of a litigator, diplomacy of a career diplomat and patience of Job.  I’m not really sure how he’s managed all this, but I’m smart enough not to ask.  He’s one of those folks who just does everything well, and can be relied upon with difficult jobs.  In addition, I know he is a source of advice and counsel to many of our junior faculty.

Screen Shot 2013-05-24 at 4.07.30 PMChris Ward has quietly, effectively, deliberately reformed our teaching in basic science through his leadership of the Normal Human Function course, and dedicated participation in our Curriculum Committee.  He has also found ways to interact effectively with clinical course directors and thereby promote integration of basic and clinical science in our curriculum.

wilsonRuth Wilson has generously taken on the considerable challenge of chairing our Professional Foundations Committee.  Her steady leadership has guided and promoted the development and integration of those essential components of our curriculum. 

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Andrea Winthrop, in a short period of time back at Queen’s, has taken on and successfully engaged a number of challenging and critical portfolios, including Clerkship Director and Chair of the Course and Faculty Review Committee.  She has also been the person most responsible for developing and managing our successful exchange program with the University of Queensland.  In all these roles, Andrea brings incredible energy, commitment and an attention to detail that is both apparent and rather astounding to everyone who works with her.  Her dedication to the welfare of our students is obvious to all.

013Brent Wolfram has quietly and effectively assumed responsibility for the Family Medicine clerkship, as well as providing valuable contributions to our Course and Faculty Review and Curriculum committees.

In addition, many faculty have provided leadership as Course Directors:

Screen Shot 2013-05-27 at 9.26.05 PMMichael Adams who has energetically revised the curriculum and teaching of Fundamentals of Therapeutics, receiving important recognitions for his teaching from the students and university in the process.

Stephanie Baxter who developed our Ophthalmology curriculum, recently transferring that role to Jim Farmer

Cheryl Cline has been instrumental in developing and leading the Professional Foundations course content.

Basia Farnell has taken on leadership of our Term 2 Clinical Skills course.

Melissa Fleming leads the challenging Perioperative Medicine rotation in our Clerkship, which integrates experiences in Anaesthesia, Emergency Medicine and Surgical Subspecialties.

Keith Gregoire who has recently taken on responsibility for the Pediatrics Clerkship, building on the program developed by Richard VanWylick and Maxine Clarke.

Russell Hollins has directed and supervised Elective rotations for many years, an administratively and educationally challenging role very important to our students as they consolidate their career directions.

Robyn Houlden and David Holland have developed a very effective Renal-Endocrine curriculum in second year.

Paula James and her colleagues have developed and implemented a course in Blood and Coagulation that is consistently very highly regarded by our students.

Paul Malik coordinates and teaches many sessions of the Cardiovascular component of our Cario-Resp course.

Romy Nitsch has expanded and refined the teaching within our Reproduction and Genito-urinary course.

Chris Parker and Armita Rahmani have worked diligently with Sue Moffatt to develop and deliver the first interation of Clerkship Curriculum Courses, which was very highly rated by out students.

Lindsey Patterson directs the development and delivery of Technical Skills within our curriculum.

Stuart Reid directs our Neuroscience course which, under his leadership, has undergone considerable revision in both content and teaching methods which have resulted in a much more effective and well reviewed curriculum.

Richard Thomas directs the Obstetrics and Gynecology rotation within our Clerkship, traditionally one of our most highly rated rotations, and a discipline where our students have excelled in their Medical Council of Canada examinations.

Shayna Watson has been a very effective liaison with the Oncology group, directing the integration of that content within our “GOP” course.

I also wish to make special mention of two Educators who have been essential components of our school and our transformation process:

Screen Shot 2013-05-27 at 2.29.05 PMSheila Pinchin has been central to our curricular reform since the outset.  She now leads a highly effective educational support team (Theresa Suart, Eleni Katsoulis, Alice Rush-Rhodes, Catherine Isaacs) and remains a key member of our leadership team, providing sound and practical advice, while maintaining a critical link to our students that allows us to understand and respond to issues and concerns.

Screen Shot 2013-05-24 at 4.15.59 PMElaine VanMelle was an original member of our Curricular Review group and, in those formative days, provided sound guidance and insights as to relevant educational theory that allowed us to ensure our changes were solidly grounded.  Her work as the original chair of our Teaching and Learning Committee led to policies and practices that were instrumental in our accreditation success and continue to guide the curriculum.

Finally, our Undergraduate support staff, under the capable leadership of Jacqueline Schutt, provide highly effective and much appreciated support to our students throughout their years with us.  In recent Canadian Graduation Surveys, the students have rated our support services well above national averages.

The origin of the phrase “it takes a village to raise a child” is obscure, but appears to derive from an African proverb.  Whatever the origin, it is certainly well applied to the tremendous effort that has gone into our curricular evolution here at Queen’s.

What motivates all these people?  Certainly not simply the money or prestige, both of which are entirely inadequate to their contributions.  In all cases, the primary motivation is a remarkable dedication to our school, our students, and the very best interests of our profession.  They deserve our admiration and our gratitude.

 

Anthony J. Sanfilippo, MD, FRCP(C)
Associate Dean,
Undergraduate Medical Education

 

 

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Why should you teach Clinical Skills?

Today’s blog article comes from Dr. Cherie Jones, MD, FRCPC,
Course Director, Clinical and Communication Skills and Ms. Kathy Bowes, RN, Clinical Skills Coordinator.

Clinical Skills training is core to any undergraduate medical curriculum. Here at Queen’s University, first and second year medical students learn “the tools of their trade” in a variety of settings and formats every week. Medical students and clinical skills tutors identify the small group teaching as the most useful and enjoyable aspect of the entire program. Furthermore, despite the significant time commitment clinical skills tutors report that the afternoon small group teaching is a highlight of their week.

“Students are so excited to be finally looking and acting like doctors with their white coats, new stethoscopes…. (they are) keen to learn the skills they associate with physicians. At this stage we can really influence the way they will interact with their patients and the type of physician they will eventually be.”

Dr. Jay Engel MD, FRCPC, Division Head of Surgical Oncology, KGH

In the pre-clerkship clinical skills curriculum, much of what is learned by students occurs in a small group setting of ten students supervised by two tutors. Once a week they meet for an afternoon and tutors guide and direct their students so that they can learn the history taking and physical exam skills that are essential to the competent practice of medicine. This year we asked tutors “Why do you teach clinical skills?”, especially since many return year after year. As most eloquently stated by Dr. Peter Froud….

“Because for many years I have felt that some of the most necessary skills for MDs are those that involve listening and questioning skills and the self-confidence needed for these skills… if I am able to impart all or most all of these skills to a group of new students every year, in my own small way I will be helping….”

Clinical skills tutors take their jobs very seriously. They feel that the role they play in providing feedback is critical for making good doctors; whether it be in the context of interacting with their students every week or during the time outside of the scheduled curriculum correcting case write-ups, reviewing reflection essays and communicating narrative feedback over the course of the term.
Additionally when tutors were asked what advice they would have for physicians interested in becoming tutors, one of our award winning tutors responded …..

“…..I seem to be more confident at it (teaching clinical skills) then I originally thought I was …. now I recognize that I possess professional expertise that not every tutor will have, and that I bring something unique and valuable.”

Clinical Skills tutors teach basic skills for future physicians. It begins with teaching students how to use shiny new stethoscopes, interact with patients, and culminates in the making of a medical student who is well equipped to enter clerkship. At Queen’s University tutors who have participated in clinical skills teaching find it rewarding, one hopes because they have come to realize that their input is critical if we are to create the next generation of competent physicians.

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Why should you teach Clinical Skills?

Today’s blog article comes from Dr. Cherie Jones, MD, FRCPC,
Course Director, Clinical and Communication Skills and Ms. Kathy Bowes, RN, Clinical Skills Coordinator.

Clinical Skills training is core to any undergraduate medical curriculum. Here at Queen’s University, first and second year medical students learn “the tools of their trade” in a variety of settings and formats every week. Medical students and clinical skills tutors identify the small group teaching as the most useful and enjoyable aspect of the entire program. Furthermore, despite the significant time commitment clinical skills tutors report that the afternoon small group teaching is a highlight of their week.

“Students are so excited to be finally looking and acting like doctors with their white coats, new stethoscopes…. (they are) keen to learn the skills they associate with physicians. At this stage we can really influence the way they will interact with their patients and the type of physician they will eventually be.”

Dr. Jay Engel MD, FRCPC, Division Head of Surgical Oncology, KGH

In the pre-clerkship clinical skills curriculum, much of what is learned by students occurs in a small group setting of ten students supervised by two tutors. Once a week they meet for an afternoon and tutors guide and direct their students so that they can learn the history taking and physical exam skills that are essential to the competent practice of medicine. This year we asked tutors “Why do you teach clinical skills?”, especially since many return year after year. As most eloquently stated by Dr. Peter Froud….

“Because for many years I have felt that some of the most necessary skills for MDs are those that involve listening and questioning skills and the self-confidence needed for these skills… if I am able to impart all or most all of these skills to a group of new students every year, in my own small way I will be helping….”

Clinical skills tutors take their jobs very seriously. They feel that the role they play in providing feedback is critical for making good doctors; whether it be in the context of interacting with their students every week or during the time outside of the scheduled curriculum correcting case write-ups, reviewing reflection essays and communicating narrative feedback over the course of the term.
Additionally when tutors were asked what advice they would have for physicians interested in becoming tutors, one of our award winning tutors responded …..

“…..I seem to be more confident at it (teaching clinical skills) then I originally thought I was …. now I recognize that I possess professional expertise that not every tutor will have, and that I bring something unique and valuable.”

Clinical Skills tutors teach basic skills for future physicians. It begins with teaching students how to use shiny new stethoscopes, interact with patients, and culminates in the making of a medical student who is well equipped to enter clerkship. At Queen’s University tutors who have participated in clinical skills teaching find it rewarding, one hopes because they have come to realize that their input is critical if we are to create the next generation of competent physicians.

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Meds 2013 – Congratulations, thanks and one more story.

This week, Meds 2013 will become the 157th class to graduate from the Queen’s School of Medicine.  Despite that long history, their experience in medical school has been distinct in many ways from the 156 classes that have preceded them.  In part, that uniqueness has been due to their engagement of novel teaching methods.  Beginning with the “Pearls” session during Orientation Week (see photo below), the use of clinical and personal “stories” and reflections has been woven into their learning.  With that in mind, I offer another “story” as a parting gift to this special class.

Class of 2013

Professional sport is sometimes capable of becoming more than just games played by privileged millionaires.  On those increasingly rare occasions it becomes a metaphor, with lessons that can resonate through other aspects of our lives.

In the late 1980s, while training in Boston, I developed a fascination with basketball or, more specifically, the Boston Celtics.  The starting five of the Celtics at that time consisted of players who had all enjoyed great careers – Larry Bird, Kevin McHale, Robert Parrish, Danny Ainge and Dennis Johnson – but, by that time, they were all well past their peak, suffering from a variety of physical ailments common to the older athlete – backs, knees, shoulders.  Nonetheless, they remained a highly competitive team, largely because of their incredible savvy, guile and, most importantly, teamwork.  They were masters of the game and very familiar and comfortable with each other.  They were therefore able to consistently defeat younger, more physically talented teams.  They remained the team to beat, and were annually competing for the championship.

basketball1The best individual player at that time, by far, was Michael Jordan.  Still early in his career, Michael Jordan was like an alien dropped to earth to show the world a new way to play basketball.  He did things no one else could do, and did most of them while seemingly suspended in mid air.  He transformed basketball into a three dimensional game.  He literally, and figuratively, soared.  However his team, the Chicago Bulls, had no players who could complement his excellence.  Their main strategy was “get the ball to Michael”.  In a game where only five players compete at a time and one athlete can play almost the whole game, this approach can be quite effective if you have such a stellar player.  Indeed, Jordan dominated the regular season, finishing miles ahead of anyone else in the scoring race, leading his team to the playoffs in 1986, and a much anticipated match with the Celtics.  For basketball fans, it was a match for the ages, pitting a great team of very good veteran players against an incredibly talented star in his ascendancy.  For basketball mad Boston, it was nirvana.

The teams split the first 6 games, with the Celtics using the standard strategy against Jordan, which was to double or triple team him.  Basically, the approach was to assign one of their tallest and most skilled players to cover the 6’6” (not very tall for basketball) Jordan, moving another player or two over as soon as he got the ball, thus boxing him in laterally and vertically.  By doing so, a team could hope to hold Jordan to 20 or 25 points, which would be regarded as a highly successful defensive effort.  For Game 7 in Boston, the Celtics shocked their fans and all those watching by taking a dramatically unconventional and courageous approach.  They decided to play Jordan man-to-man and, for most of the game, Dennis Johnson was assigned the task of covering Jordan.

Dennis Jordan was a very capable guard who had a long and successful career.  He had become a key component of the Celtics team and knew his role very well.  However, he was only 6’4” and, by 1986, couldn’t jump.  Basically, he had no chance of covering Michael Jordan alone.

basketballThroughout the game, the highly knowledgeable Celtics fans watched in shocked disbelief as poor Dennis was left to do the impossible.  For a proud athlete with the entire basketball world watching, including his wife and children who were in the crowd, it would have been a humiliating experience.  Michael Jordan scored in every possible way, eventually amassing an amazing 63 points – still the record for most points in a professional post-season game.  But…the other four Celtics starters, freed from defensive responsibilities, all dominated their opponents and Boston won the game in double overtime – the most exciting and interesting basketball game I’ve ever seen.  The team of grizzled and self-sacrificing veterans had triumphed over the transcendent star, at least that night.  After the game, as players and fans swarmed the court, it was obvious that Jordan felt defeated and unfulfilled despite his incredible personal triumph.  Dennis Johnson, on the other hand, emerged as the battered hero of the game despite his personal drubbing.  He became, and has been, my favourite basketball player.  I was saddened to learn of his premature death in 2007 from apparent cardiac causes.  His Celtics teammates eulogized him as “one of the most underrated players of all time”.

So, what relevance does this story hold for the newly minted doctors of Meds 2013?  You are about to engage postgraduate training of various types.  You will, believe it or not, become highly proficient in your chosen specialties.  You will have days when you feel capable of handling any challenge – of being able to soar like Michael Jordan.  On those days, it will serve to recall the lessons of that April 1986 game, that you can lose the game despite personal triumph, and that even Michael Jordan never felt fulfilled as a player until years later when the Bulls assembled teammates capable of complementing Jordan’s talent and finally winning championships.  By all means, strive to soar, but remember that most of our triumphs as physicians come when we toil with integrity like Dennis Johnson; without fanfare, with quiet effectiveness, with very few aware of what we’ve done, with the patient’s welfare as our ultimate goal.

Meds 2013 has been a remarkable class.  An eclectic and unassuming mix of the quirky and conventional, the pragmatic and idealistic.  Gracious and accepting in the midst of massive curricular change, unfailingly supportive of their school, of their world, of each other.  You have earned the respect and affection of your faculty who will proudly follow your careers with great interest in coming years.  It has been our pleasure.

 

Anthony J. Sanfilippo, MD, FRCP(C)
Associate Dean
Undergraduate Medical Education

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New Material and a New Way to Learn: Students as Teachers on Grief.

Recently in a second year meds class, we were debriefing the experience our 2015 meds students had with their “First Patient Project.” During that debriefing class, we had relatively unique and very engaging learning experience about a serious and under-reported topic. My thanks to Dan Corazolla, Soniya Sharma, Lindsay Bowman, Aaron Wynn, Heather Johnston, and Mason Curtis, all Meds 2015 for their help with this article.

The First Patient Project is an 18 month project which begins right in September of medical students’ first year and continues until after December of their second year. Students in pairs follow a chronically ill patient, attending health care appointments and visiting with them in their home. The students also interact with community and faculty physicians and complete critical analysis reports about their learning.

This day, on April 30, we heard from six “student teachers.” Having students teach a formal session is reasonably unique in our medical school and the topic of their teaching was also reasonably unique in medical literature: How do physicians deal with grief, on the loss of a patient? How do they recover and go on…down the hall to the next ward room with another patient in it, to another clinic room, to home?

Six of our students encountered death over the program…two of our “Patient Teachers” sadly have died over the past two years. And another pair of students lost their patient as she was the spouse of one of the patients who passed away and could not continue with the program.

The six students met with a clinical faculty member to discuss the experience, and individual discussion/counseling was made available to them. But they also continued with the project by doing research on three areas: 1. How physicians help families when a family member dies 2. How physicians can help themselves when a patient dies, and 3. How medical literature and medical education literature give insight on how to bring this up in medical education.

Their research and presentations were excellent! I thought I’d share, with their permission, some of their findings:

From Soniya Sharma and Dan Corazolla, came these concepts in how physicians can help their patients deal with grief: the differences between “normal grief” and “abnormal grief”, the tasks of grieving, the family as a resource, and the role of the physician. They consulted nine current references to expand upon these concepts to their classmates and to link up with previous sessions on this topic in their first year classes.

The title of Lindsay Bowman’s and Aaron Wynn’s talk was “Wearing your heart on your jacket: Patient death and the importance of physician grief. “ They pulled from fifteen diverse sources from Military Medicine (great article on resilience-building) to Vasalius, (How to cope with disaster loss and mourning: Galen’s paper which was lost for centuries) to more traditional medical and medical education journals. One particular source I found intriguing was J. Shapiro’s article in Perspective: Does Medical Education Promote Professional Alexithymia? A Call for Attending to the Emotions of Patients and Self in Medical Training. Acad Med 2011;86:326-332.

Lindsay and Aaron taught convincingly about the factors that make patient death difficult to deal for physicians, why grief education is important and relevant to physicians and medical trainees, the current state of grief education in our curriculum and that of other medical schools and where it could and should be represented in undergraduate and postgraduate medicine.

The third partnership to teach about this topic consisted of Heather Johnson and Mason Curtis. Their teaching centred around healthy strategies for physicians in dealing with grief. Both Heather and Mason conducted surveys or interviews. Heather’s survey inquired into when and how we should teach about physician loss and grief in our curriculum. She gave practical strategies and a model on how to move through loss and grief and created a “grief curriculum” whose components could be shared with faculty as well as students.

Interestingly both Heather and Lindsey focused on an article that, in their words, “if you had to read only article on this topic,” this would be it: The inner life of physicians and the care of the seriously ill by Meier, D.E. et al in JAMA 2001, 286(23): 3007-14. I’ve just read it too and let me chime in—a very thorough and insightful article on this topic.

Mason had interviewed physicians and created a model of grief approaches from three perspectives. He also spoke movingly about how he had responded to his grandfather’s death at a time when in medical school he was learning about oncology, palliative care and the elderly.

Students in the class afterward said that it was really positive to learn this material from their classmates. The work was solid, the literature review broad, and the points very clearly and thoroughly presented with good handouts.

The students who taught were positive too…tho’ some had not been initially  Some were hesitant to teach their classmates, and concerned that it would not be well received. They were really buoyed up by the great feedback from their peers and from faculty Dr. Sanfilippo and Dr. Leslie Flynn, Kathy Bowes, Program Coordinator, Erin Matthias, Program Assistant, and patients in the room.

What’s the next step? Well, the students and I can see a need for further exploration of this subject in clerkship and residency. As well, I hope the students will put together a poster about this for CCME.

My take on this aspect of the project is this: our six student teachers were excellent teachers! They were well-prepared, and had done a thorough job in finding out in different modes and in some cases ferretting out literature on a topic that seems to be localized in only a few aspects of medicine and medical education. They were clear speakers, and had great teaching points. Their slides were excellent and they had a good beginning, middle and end to their talks. They were convincing, authoritative, and had much to share. Turning some of the teaching over to students teaches those who teach, and their classmates. We already do student small group teaching in our Community Based Projects and our Nutrition Projects—maybe some large group teaching is in order?

Beyond the teaching method, the students taught us all about a part of medicine that appears to be kept somewhat quiet. About the culture of a “stiff upper lip” that could pervade in some medical cultures. About how may physicians act differently about their own grief than they would advise a patient to act. They gave us all a lesson in how to cope in a healthy way, when you have to move on…to the next patient, the next room, the next door and all the way home.

Are you interested in the reference lists from the students? Or would you like to contact them to find out more about their talk and what surprised them? Write back here, or write to them via email addresses on MEdTech.

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Curricular Leaders’ Retreat

On June 3, from 8:15-2:00, Curricular Leaders will gather for a retreat in the new Medical Building. The retreat will feature updates by Dr. Tony Sanfilippo as a “State of the Union” or report card on UGME. As well, mini-workshops on strategies in teaching and assessment will be offered. Finally updates on innovations over the past academic year and on accreditation will be offered.

Course and Unit Directors are generally the target audience of these retreats. Course Directors are invited to bring a colleague with interest in the direction of their course.

Announcements with information about the agenda, RSVP process, and location is forthcoming.

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How could I have forgotten Medical Humanities?

I arrived to the CCME amidst a huge storm on Saturday at 4:30 and immediately went off to a presentation and discussion with other Ed. Developers and new faculty in med ed. So I missed the Medical/Health Humanities Creating Spaces III symposium which had just wrapped up. However, our own Jackie Duffin did not miss it–in fact she was part of a panel on Medical Humanities to wrap up the Symposium, Medical Humanities: Whence and Whither? As well, meds students Emily Swinkin (2014) and Renee Pang (2013) presented — and a recent grad Jennifer Baxter (2012) — was attending just to listen from her family med residency in Chiliwack BC. To see more about this important initiative which I was able to attend and enjoy last year, go to http://medhealthhumanities.ca/Programme_Presentations.html

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Reflecting on Reflection

Reflection in Medical Education

I love those who can smile in trouble, who can gather strength from distress, and grow brave by reflection.–Leonardo da Vinci

I thought I’d write to you about reflection in this blog entry.  I can hear the meds students groaning already:)  You see, we ask the meds students to do a fair bit of reflection in undergraduate medical education, starting with term 1 when we ask them to reflect on being a physician, and on through to their last portfolio assignment in pre-clerkship when we ask them to reflect on how well they have progressed in their learning about the roles of a physician.

Reflect is a rather over-used and under-thought term and so as I progress through this, you may want to substitute another term.  I happen to like “critical analysis” because a lot of reflection should include that, and a lot of what we’re asking the meds students to do includes critical thinking.

When we talk to the medical students we talk to them about the stages of reflection and we use one model of reflection for learning or “reflection in and on action” (Schon, 1983), that of experiential learning by David A. Kolb.  Kolb (with Roger Fry) is well-known for his conceptualization of reflection as a critical part of learning (Kolb, 1984).  He postulates a cycle of reflection where a learner experiences something concrete (Concrete Experience), observes and reflects upon it (Observation and Reflection), generalizes the learning in Abstract Conceptualization and then applies the learning to new experiences in Active Experimentation.  This starts the cycle again, with a spiral approach so that one is not repeating the same learning over and over.    Kolb also notes that one can enter the cycle at any stage in the 4 steps.

When we present to the meds students we use this graphic:

Screen Shot 2013-04-09 at 7.28.32 AM

To me this theory is important as it allows for some very practical outcomes for reflection.  As Peter Drucker says, “Follow effective action with quiet reflection. From the quiet reflection will come even more effective action.”  Two leaders in the field agree: Dr. John Sandars defines reflection as  “A metacognitive practice that occurs before, during and after situations with the purpose of developing greater understanding of both the self and the situation so that future encounters with the situation are informed from previous encounters.” (Sandars, 2009) Jack Mezirow when writing about “transformative learning” describes reflection as critical awareness of how we are constrained, and how to reformulate so as to act. (Mezirow, 1997)

So how can we assist learners to reflect in order to change their actions? How can we promote “rigourous reflection?”

Dr. Ted Ashbury and I start by asking them to jot down some thinking:  “Think of a situation where you have said, “I’m not going to fall into that trap again. I’ve thought about this, and I know I’m prone to…”!  We show them the cartoon of Charlie Brown and Lucy and the infamous football… This is helpful because one goal of reflection can be to change action, to break a cycle or pattern.


Next, we ask the students to think about a situation that has engaged their attention in the past few weeks and fill in a chart based on the 4 steps in Kolb’s theoretical framework:

 

Identify

  • Prompt
  • Observation
  • Idea
  • Catalyst
Analyze:Make connections Prior experience

Links to knowledge of yourself

Broaden:Reinforcement, Generalizations,Perspectives,

New Knowledge

Apply/Plan (Now What?)Changes or shiftsCommitment to future action/plans

And we ask them to set some goals:  SMART Goals

Specific (straightforward, not ambiguous)

Measurable (It is clear under which conditions the goals are achieved)

Acceptable (The goals should be acceptable to all stakeholders)

Realistic (The learner should be able to achieve the goals)

Time-bound (It should be clear when the goal is to be achieved)

Free Writing:  We give students time to write—free writing for at least 5 minutes (an engaging and difficult task—I recommend it!) about the prompt from the beginning of the session or “Write about your First Patient Experience, your Clinical Skills experience, your learning elsewhere in term 1, a key challenge you have chosen to work on recently, Mid-terms…???”  We also offer them a reflection written by a student in another meds school and a rubric that Eleni Katsoulas and I  designed to help us and them assess reflective writing.  They get to analyze their colleague’s writing based on the rubric:

Prompt or Catalyst Ideas (What?) Connections (So what?) Extensions (Now what?)
Observed behaviours of other Describes the behavior and the context in which it occurred -Interprets the behavior, its cause, or provides a rationale  (impact)-Seeks out primary resources/information/circumstances, to connect to and make sense of the observation  – Provides an alternative to problematic behavior based on consideration of all primary observations-Discusses implications and considers how or whether to implement change in their own behaviour-Problem may be reframed, and there is an explanation of how this represents a change from previously held beliefs

-Considers impact of framework on behavior (culture, system, etc.)

-Commits to future  action, reflection, or advocacy

 

This seems like a lot of work to accomplish reflection, doesn’t it?  However, it’s like learning skills for anything…we provide opportunities to break down the skill into discrete parts, and learners time to practice.  The idea is that the more they practice this, the more intuitive and natural it becomes.  This doesn’t negate the possibility and importance of a 30 second reflection on an interesting, provocative, or disturbing matter, but it does lead, we hope to rigourous reflection.

I thought I’d finish this section with a quotation from a medical student who was reflecting:

“If I had to choose what I felt to be the most important thing that I have taken from these experiences, it would be to remind myself, no matter how I feel, to think about how the patient is feeling. To never forget that off-hand comments made when tired or stressed have the potential to upset people to such an extent that they remember them for years.” (Macauley & Winyard, 2012).

If this is the result of rigourous reflecting, I’m all for it!

What are your thoughts on reflection in medical education?  What use do you see for it? (or do you see a use?) What strategies do you recommend?  In the next blog, I’ll send some tips for reflection, along with your suggestions.

 

Sources

Kolb, D. A. (1984) Experiential Learning, Englewood Cliffs, NJ.: Prentice Hall.

Kolb. D. A. and Fry, R. (1975) ‘Toward an applied theory of experiential learning;, in C. Cooper (ed.) Theories of Group Process, London: John Wiley.

Schön, D. (1983) The Reflective Practitioner, New York: Basic Books

Saunders, John. (2009). The use of reflection in medical education: AMEE Guide No. 44. Medical Teacher, 31(8), 685-95.

Mezirow, Jack. (1997). Transformative Learning: Theory to Practice. New Directions for Adult and Continuing Education, 74, 5–12.

Macauley, CP & Winyard, PJ. (2012). Reflection: tick box exercise or learning for all? BMJ Careers.  http://careers.bmj.com/careers/advice/view-article.html?id=20009702

 

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Making D.I.L. an important part of teaching

In our model of Small Group Learning (SGL), we ask students to prepare for the SGL class by independent study of a text, online module or lecture, directed by the faculty.  This “Directed Independent Learning” (DIL) is often used, but how well is it used?

If we view the DIL as a way to have a “second” teaching session with the students, this allows us to give support, explanations and/or a rationale for the reading or viewing they are doing.

A recent study advocated 10 minute “supportive” podcasts as a way to help students understand the purpose and the key concepts and terminology in a reading prior to a group learning task.  The instructors chose podcasts as a way to connect with students and allow them to listen anytime and anywhere.

Whether you use a podcast, or simply write in the Teacher’s Message in MEdTech, here are some possible aspects of “teaching” with readings you can incorporate in your “DIL” teaching.

  • An introduction that explains why the reading had been chosen and how it links with course content or upcoming tasks;
  • Guidance on the key elements in the assigned reading on which students should focus;
  • Elaboration of particularly difficult content, including different ways of phrasing or explaining essential theoretical concepts;
  • Background on any concepts new to students and not explained in the reading with the goal of creating a context for the reading;
  • Grounding questions described as “designed to help students relate the material to their personal/professional reality.” (p. 82) In other words, questions that encouraged students to think about how the material applied to their interests and circumstances.

What are your thoughts on using this as a method to connect with students outside the classroom?

Taylor, L., McGrath-Champ, S., and Clarkeburn, H. (2012). Support student self-study: The educational design of podcasts in a collaborative learning context. Active Learning in Higher Education, 13 (1), 77-90.

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